How to reduce eczema-flare ups?

A more severe form of very dry skin, irritated skin with itching is considered atopic skin. This skin disease (disorder) starts at a very young age and has all the characteristics of a genuine epidemic. It is even one of the main causes of visits to the dermatologist! In the past 30 years, the number of cases of atopic dermatitis has doubled or even tripled in western countries*. Eczema-prone skin is not well known or understood, yet it disrupts the lives of children and their parents. However, recent scientific discoveries have improved understanding of the illness and changed the way it is treated starting at birth.

What are the signs of eczema-prone skin?

Eczema is an inflammatory skin disease that is characterised by extreme dryness and red patches often covered with small vesicles (small “blisters”) that cause intense itching.

Eczema is a benign and non-contagious chronic condition that causes periodic flare-ups.

These acute break-outs have a significant impact on quality of life and often cause insomnia. Over time, an atopic profile can manifest in other allergies such as asthma, allergic rhinitis or allergic conjunctivitis. The complications are bacterial or viral (herpes) secondary infections. Molluscum contagiosum, a viral skin condition, is also more common in children with eczema-prone skin.

What causes eczema?

The skin is extremely dry and becomes more permeable, no longer playing its barrier role against external stresses and allergens. But not all dry skin becomes eczema.

Eczema develops on profiles with a genetic predisposition.

Studies have shown that if one parent has eczema-prone skin, the probability of the child having the same skin condition is 30%**. If both parents are affected, the probability is 70%**.

In addition to the genetic factor, eczema-prone skin is also related to:

An abnormal immune system: which over-reacts, creating inflammation. The epidermis becomes permeable to allergens (mites, animal hair, pollen) and certain bacteria (Staphylococcus aureus), which trigger inflammatory reactions.
Food allergies: cow’s milk, eggs, etc. are also involved digestively in triggering certain eczema flare-ups. Other factors such as chemical products applied to the skin, heat or perspiration are irritants that cause these flare-ups.

However, in the vast majority of cases, children who have eczmea do not have food allergies. Food allergies manifest themselves as digestive signs and a “break” in height and weight curves.

* Atopic dermatitis: epidemiology in France, definitions, natural history, association with other atopic manifestations, severity scores, quality of life (Atopic dermatitis: Epidemiology in France, Natural History, Association with Other Atopic Manifestations, Severity Scores, Quality of Life) . E. Mahé. Ann. Dermatol. Venereol. 2005; 132

**Dermatite atopique. SA Büchner. Swiss Medical Forum No. 19, May 2001

Eczema progression

Eczema generally starts between the second and third months of life when highly-localised red patches appear on the cheeks, and hands, then spread to flexion creases on the knees and elbows. The illness evolves through flare-ups over one to two years.

The skin is permanently dry, which leads to itching, causing insomnia and a decrease in quality of life.

After several years, some children may develop other atopy signs, such as allergic rhinitis and/or allergic asthma. This is the last stage of the “atopic march”. It often involves scratching and high rates of staphylococcus aureus colonization on the skin.

Therefore, in order to prevent it from appearing and worsening, the scientific community currently recommends early management from birth to treat atopic skin in newborns who do not yet show signs of the condition but who have a favorable genetic predisposition.

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Who is affected?

People affected are genetically prone to allergies (eczema-prone).
They may also have respiratory problems (asthma), problems in the ears, nose and throat (allergic rhinitis), eye problems (allergic conjunctivitis) or digestive problems (food allergy).
Babies and infants are the most likely to be affected, usually between three months and five years, with a peak of 80% of cases appearing before the age of one. But atopic skin can persist longer, up to adulthood.

What should I do?

A dermatologist is the best resource for identifying skin disorders, finding the cause of your skin issues, and developing an adapted treatment. Please consult your dermatologist, doctor or pharmacist so that they may best advise you on your personal skin regimen.

Once the progressive nature of atopic dermatitis was understood, a new approach to the disease was adopted with two key objectives that should encourage you to contact your dermatologist.

What strategy should be adopted to manage a progressive disease?

We should short-circuit the progression and act as early as possible, in the stage of “pre-eczema” dryness in at-risk infants: those whose skin is very dry, whitish and rough, and those whose parents or siblings have had eczema-prone skin.

How should this be done? By intervening as early as possible with the most targeted treatment available, because each atopic dermatitis flare-up promotes new relapses.

It is essential to treat each flare-up in a drastic way, which will limit the reappearance of lesions and reduce the length of the illness’s progression.

Medicated treatments for eczema flare-ups mainly rely on local topical treatments. They eliminate dry irritated irregularities and provide relief. The lesions frequently recur when treatment is discontinued. Food elimination diets are only justified after medically confirming a food allergy (using food allergy tests in a specialised environment).

Be sure to follow all of your dermatologist’s advice. Remember to take the following precautions:

Avoid allergens likely to cause an acute inflammatory reaction such as mites, pollen and animal hair and feathers, as well as exposure to tobacco, which is an irritant.
Avoid introducing solid foods too early for infants. Follow the advice of your paediatrician or general practitioner.
Opt for cotton clothing. Avoid wool and synthetic clothing that could irritate skin.
Be careful not to use too much detergent when doing laundry. Too much detergent may make skin fragile.
Remember to iron your clothes or tumble dry them. This will make them softer and more comfortable.
Make sure the temperature in your home is not too hot (19-20°C) and regularly humidify the air. Air rooms every day, both summer and winter.
Regularly humidify your bedroom or simply hang a wet towel in it overnight.
There are no restrictions on sports unless excessive perspiration aggravates itching.

Every day, take a five- to ten-minute shower with warm water (it should not be more than 35 degrees Celsius; dry skin does not like hot water).
Do not use bubble baths or bath salts, which always dry out and irritate the skin.
Wash your body with an ultra-high-tolerance cleansing product; ideally a liquid Syndet or a lipid-enriched and anti-dryness cleansing bar (to contribute to strengthening the skin barrier). Say goodbye to ordinary soaps because they irritate and dry out the epidermis.
Meticulously dry skin, carefully and lightly dabbing it with a cotton towel.

Once or twice a day, generously apply an ultra-high-tolerance emollient that promotes the reconstruction of the skin barrier, makes your skin supple and soft and reduces hyper-reactivity.
Once or twice a day when experiencing eczema flare-ups, use a moisturizing and superfatting treatment that relieves itching and limits inflammatory reactions on your whole body except on eczema lesions.